Create a Will If you are human, leave this field blank. Your Details Title Mr Mrs Miss Revd Dr Lord Lady Sir Captain Professor The Honourable the Right Honourable First Name Middle Name Last Name Date of Birth Username Password Email Address Postcode Address 2 Address line 2 if needed Suburb Mobile Number 1 / 3 Are you Covered? Do you have Life Insurance? Yes No Do you have funeral cover? Yes No Executors How many Executors do you require for your Will? One Person Two People Three People Four People Title - First Executor Mr Mrs Miss Revd Dr Lord Lady Sir Captain Professor The Honourable the Right Honourable First Name - First Executor Middle Name - First Executor Last Name - First Executor Title - Second Executor Mr Mrs Miss Revd Dr Lord Lady Sir Captain Professor The Honourable the Right Honourable First Name - Second Executor Middle Name - Second Executor Last Name - Second Executor Title - Third Executor Mr Mrs Miss Revd Dr Lord Lady Sir Captain Professor The Honourable the Right Honourable First Name - Third Executor Middle Name- Third Executor Last Name - Third Executor Title - Fourth Executor Mr Mrs Miss Revd Dr Lord Lady Sir Captain Professor The Honourable the Right Honourable First Name - Fourth Executor Middle Name - Fourth Executor Last Name - Fourth Executor Details Do you wish to be an Organ donor? Yes No If Yes, which organs do you wish to donate? Eyes Kidney Liver Skin Hand Foot Whole body How do you wish to dispense with your body? Burial Cremated Scientific Research Special Gifts Do you wish to provide someone with a special gift? Yes No Do you wish to donate some funds from your estate to a charity? Yes No Beneficiaries How many Beneficiaries do you want to receive a portion of your Estate? One Person Two People Three People Four People Five People Six People Title Mr Mrs Miss Revd Dr Lord Lady Sir Captain Professor The Honourable the Right Honourable First Name - First Beneficiary Middle Name - First Beneficiary Last Name - First Beneficiary Relationship to you - First Beneficiary Do you wish to provide the Beneficiary a percentage of your Estate or a precise sum? Percentage of Estate Precise sum Percentage of Estate (%) - First Beneficiary Precise Sum - First Beneficiary What is to happen to their share if they do not outlive you by 30 days? Their share gets passed on to their children, or if no children, to their next of kin Their share is equally divided amongst the remaining beneficiaries Their share is passed on to another person Title Mr Mrs Miss Revd Dr Lord Lady Sir Captain Professor The Honourable the Right Honourable First Name Middle Name Last Name Exclude Someone Do you wish to exclude someone from your Will? Yes No If Yes, how many people do you wish to exclude from your Will? One Person Two People Three People Four People Five People Six People Excluded from Will - First Person Title Mr Mrs Miss Revd Dr Lord Lady Sir Captain Professor The Honourable the Right Honourable First Name Middle Name Last Name Witnesses First Witness Title Mr Mrs Miss Revd Dr Lord Lady Sir Captain Professor The Honourable the Right Honourable First Name Middle Name Last Name Second Witness Title Mr Mrs Miss Revd Dr Lord Lady Sir Captain Professor The Honourable the Right Honourable First Name Middle Name Last Name First Attorney Title Mr Mrs Miss Revd Dr Lord Lady Sir Captain Professor The Honourable the Right Honourable First Name Middle Name Last Name Second Attorney Title Mr Mrs Miss Revd Dr Lord Lady Sir Captain Professor The Honourable the Right Honourable First Name Middle Name Last Name Witnessed By Solicitor Title Mr Mrs Miss Revd Dr Lord Lady Sir Captain Professor The Honourable the Right Honourable First Name Middle Name Last Name Date of Power of Attorney 2 / 3